ComplaintsforAustin Retina Associates - Round Rock

• Initial Complaint

  04/01/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I went to retina and Round Rock, because my eyes became very blurry. After several exams, injecting die in my body . They told me I had leaking vessels. And provided shots in my eyes very painful a few months ago by and there was no improvement so after skipping out on the next appointment, they called me to set up an appointment to see how I was doing. I explained to them the medicine did not work, and I would not be going back, I was out almost $800. thats when they told me over the phone they had given me the generic brand and they have a better stronger brand that would probably work for my eyes, so they convince me to give them another try so I went to my appointment and they did the same exams and the same die in my body and Doctor ***** was gonna inject my eyeballs with the better medicine and before injecting, I confirmed with him that I will be getting the better medicine (not generic brand) he said yes. So he walked out the door came back with a needle and injected, my eyeballs again very painful. So a few months go by I called them let them know that the medicine was not working and thats when I found out they injected the generic brand in my eyes again!! I was furious and disbelief when they told me this. So I told them I will not be paying my bill since I did not get what I ordered and asked to speak to a manager I Reached out to them several times to resolve this they have lied to me told me that the managers would call me back then told me managers couldnt help me. Ive left messages absolutely nightmare and now they keep billing me for $600. I really need your help here they have even confirmed that I was at the doctors office to get the non-generic brand , there was notes in the system. This is my eyesight were talking about should not be allowed to do this to people. I was in shock after finding out they gave me the same medicine and thats why Im reporting it

  Business response

  04/04/2024

  To whom it may concern:

  I would like to reassure you we do not have "generic" medications here in our office, so please feel assured you were not treated with a generic of another drug.

  Your insurance, BCBS requires our office to do what is called step therapy, which means we have to follow their guidelines to do a less expensive drug, and then move onto the drug we prefer. This is what happened in your case. Since you had not been seen in roughly 17 months, and you came in with a new insurance, BCBS required us to begin step therapy with the Avastin to establish a baseline. Thankfully, we did receive an authorization approval with a starting date of 7/27/23, to treat you with the intended medication Verteporfin (Visudyne), but you have not retunred to our office since 7/26/23.

  It looks like you have spoken with ****** who schedules our ***'s (Visudyne appointments) on 8/17/23 and 8/18/23 to discuss treatment and finances. It looks like you also spoke with one of our supervisors, ******* on 12/28/23 and 1/5/24 to discuss future treatment.

  I do see notes from your visit in July where our physican advised you about the recurrent fluid in your eye and reccomended bilateral avastin day of in hopes to reduce fluid, and if it did not resolve or the issue persists we would move forward with the *** (Visudyne) treatment. Our physican recommended you follow up with your PCP about the testosterone injections and how that could be effecting your CSR in both eyes, and that there could be a complication or atypical wAMD component. That this could be causing the spot in the central field of your left eye or the "dirty window" effect.  But nothing mentioning other treatments.

  The only other note in the system mentioned your desire to pay for the treatment out of pocket due to a high deductible of $5000 individual, and $10,000 for the family coverage, but it was determined you wouldnt do this at the time of service, and we would bill your insurance. We have billed your insurance for the office visit, testing, and treatment you had on 7/26/23, and they left everything out to your deductible without paying. As this is left to your deductible we are unable to offer any discounts or further deals, as we must follow what the insurance responds with, we are at the mercy of the contratcted obligation we have with your insurance, as are you the patient. Your agreement with your insurance states you pay your deductible before they apply any coverage, we are in the same boat.

   

  Customer response

  04/04/2024

  Complaint: 21515027
  
  I am rejecting this response because:
  
  Regards,
  
  *************************

  All of your staff lied to me I wouldve never never agreed to have the same medicine. I understand what youre saying about the insurance company Dr ***** and the lady that called me to book my appointment for the different medicine and thats the only reason why I went.   instead, I went through the whole process, thinking I was gonna have better results somebody shouldve told me that this was my only option and I wouldve rejected and walked out. 
  instead, you put me through pain to get zero results AGAIN ! I will never do business or trust Austin Retina  

• Initial Complaint

  12/12/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On August 17, 2022 and October 18th, *********************************************** which **************** told me was a sample and would not cost anything. However, there are office visit charges, which I do understand. When I received a billing for the August visit, I asked Austin Retina to submit to my insurance (Freedom Life apart of the ***************). They did and to my discovery, it was not covered due to the type of policy I had with Freedom Life. This part was my error. I called my insurance company and they explained my coverage and said that Austin Retina can rebill me as a self-pay since they (Austin Retina) never received an insurance payment. I would just need to call them. When I spoke to Austin Retina, they told me that it would be illegal for them to rebill me as a self pay. I called my insurance back and spoke to another person with Freedom Life. They told me there are no laws preventing them from rebilling as self-pay. When I called Austin Retina back, they still would not rebill. The amount of these two visits as self-pay would total about $500. They are billing me at an insurance rate (minus adjustments) totaling $1310.00. This is a large amount for me to handle and it makes me nervous to ever go back to their facility not knowing if their system would remove me as self-pay and I would once again be billed at this higher rate with no recourse. I want to pay them, but I only believe it is fair, since they never received payment from my insurance, to be billed at the self-pay rate. I feel that this is unreasonable and causes question with Business Ethics on the part of Austin Retina. I do not understand why they would force a patient to pay the same rate as what an insurance company is being billed. I might also suggest a solution, that if there is an issue with their accounting, that I would consider paying the $1310 in some manner but have the overage as a credit to my account for future appointments. They are not reasonable.

  Business response

  01/18/2023

  To my knowledge, we have not heard from the claimant directly since contacting the BBB.  I wanted to apologize for any inconvenience on the patient's behalf.  If I may, I'd like to provide you with an explanation with what may have caused the issue:
  
  ***************** had an insurance program that we do not accept so he was being billed as a self pay patient. He then got new insurance coverage so we entered it and billed it, but he is still left with his deductible and out-of -pocket costs (which is more than the self pay rates charged in 2022). He is requesting us to give him self pay discounts after we billed the insurance and we are legally not allowed to do so. ****************** also doesn't believe he should be billed for office visits since he won't allow us to dilate him, but we have every medical reason and justification to bill him. 
  
  He claims that his insurance says we are "choosing" to be mean to him and that we can give him further discounts.  Such acts like he suggests can and will be deemed fraudulent for Austin Retina Associates so we are unable to fulfill his requests.
  
  As an amenable solution, I propose that a representative from Austin Retina offer to explain to him why we are being held accountable through laws and regulations that provide the legal framework for insurance regulation.   
    
  

  
  

  Customer response

  01/18/2023

  Complaint: 18557928
  
  I am rejecting this response because:

  I am uneasy about the comment about being "mean to me".  I have throughout the last year asked to have charges explained and has Chase and the BBB experienced, not response is provided.  

   

  I am requesting the laws, in which would be violated in order to ONLY rebill at a self-pay, be provided within this response.   My insurance company, and I spoke to two different individuals, did not no of any laws.   

  At this point, I am only happy to get a response.  When I did not get a response from Austin Retina on my original inquiry on new billing charges (e.g. charged for being an existing patient) and disputed those charges via Chase (whom also did not get any response) hoping to get some answers, it becomes difficult to just hand out money.  

  
  Regards,
  
  *************************

   

   

  Business response

  01/24/2023

   

  
  

  Business response

  02/09/2023

  We have spoken with this patient many times in regards to his bill previous to him filing his complaint and have provided him the same answer each time. We have provided answers to his request about the laws and rules we must follow in the in insurance and billing world.

  We have explained multiple times we can not provide further discounts as that is fraud. We have also explained if he can get something in writing from his insurance to prove what he says about providing further discounts, then we can work with him, but until then we must go by what is on the *** the insurance provides us.

   

  I dont see anything on your most recent message about what next steps are or how to handle this going forward. I only see a repeat of the previous messages.

  Customer response

  02/09/2023

  Complaint: 18557928
  
  I am rejecting this response because:

   

  I am NOT asking for a discount no more than Austin Retina wants premium payments.  AS soon as Austin Retina provides proof that it would be "Fraud" in to rebill at the uninsured rate, WHICH, was paid before, I will get written proof from insurance company.  I want the *** regulation OR the *** which states to it is fraud to rebill a client after there was NO payout from insurance.  I have also asked for this very clearly in the past, many, many times and they refuse to provide this information.  If they would stop with this fraudulent claim and admit it is their internal policy ONLY, I will pay.  
  
  Regards,
  
  *************************

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